2025 Proffered Presentations
S225: SURGICAL TREATMENT OF THIRD VENTRICLE CRANIOPHARYNGIOMAS IN ADULTS
Diego Mazzatenta1; Matteo Zoli1; Alessandro Carretta1; Marcello Magnani1; Federica Guaraldi2; Giacomo Sollini3; Sofia Asioli1; Ernesto Pasquini3; 1University of Bologna; 2IRCCS Istituto delle Scienze Neurologiche di Bologna; 3Azienda USL di Bologna
Although the endoscopic endonasal approach (EEA) allows to effectively treat the vast majority of craniopharyngiomas (Cphs) with satisfactory results, the most effective management of those with third ventricle extension remains open and could be debated. The aim of this study is the analysis of the outcome of the different surgical approaches for third ventricle Cphs in adult patients, in order to assess the correct indications for EEA and for the other routes.
Our Institutional surgical database, encompassing a timespan from 1998 to 2023, was retrospectively reviewed. All the surgically treated craniopharyngiomas with third ventricle extension were included in the case series and analyzed. The type of treatment, the preoperative and postoperative clinical and neuroradiological features were gathered and analyzed. The long – term outcome was evaluated with magnetic resonance imaging (MRI), endocrinological and ophtalmological evaluation at 3 – months and then yearly.
In the analyzed timespan, 146 Cphs in adult patients were treated in our center. Of these, 60 (41.1%) cases involved the 3rd ventricle (30 males, 50%, mean age 53, range 18-83). Endoscopic endonasal approach was performed in 46 cases (76.7%), craniotomy in 10 (16.7%) and endoscopic trans-ventricular in 4 (6.7%). Gross-total resection was achieved in 91.3% of cases operated though EEA and in 70% with craniotomy. Cystic drainage with symptoms resolution was achieved in all cases treated through an endoscopic trans-ventricular. Improvement of visual deficits was observed in 72.5% of 40 cases with preoperative visual impairment. Histological analysis revealed a papillary Cph in 24 cases (40%) and an adamantinomatous Cph in 36 cases (60%). No perioperative mortality was observed.
Neuroradiological assessment of tumor relationship with diencephalic and optic structures represents a crucial parameter for the surgical approach selection. In our experience, EEA was preferred for tubero-infundubular cases, which displace circumferentially the hypothalamus and antero-superiorly the chiasm. Conversely, for purely endoventricular forms, particularly associated to hydrocephalus, a transcranial transcallosal or pterional trans-lamina terminals approach was preferentially chosen. Elderly patients or with multiple comorbidities and poor Karnofsky score were treated with a trans-ventricular endoscopic cyst drainage to resolve the symptoms, eventually followed by radiotherapy.